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Published on: July 18, 2014
Left ventricular assist device as bridge to transplantation does not adversely affect one-year heart transplantation
Joseph C Cleveland1, Frederick L Grover, David A Fullerton
1Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA. joseph.cleveland@uchsc.edu
Insights
Left ventricular assist devices (LVADs) do not impact overall 1-year survival after heart transplant. However, patients receiving LVADs before transplant face a higher risk of early death post-transplant.
Area of Science:
- Cardiology
- Transplantation Surgery
- Medical Devices
Background:
- Left ventricular assist devices (LVADs) are increasingly utilized as a bridge to cardiac transplantation.
- The impact of pretransplant LVAD use on short-term post-transplant survival remains an area of investigation.
Purpose of the Study:
- To evaluate whether pretransplant left ventricular assist device support affects short-term survival following cardiac transplantation.
Main Methods:
- A retrospective review of 317 cardiac transplant recipients from 1986 to 2006.
- Comparison of survival rates between 23 patients supported with LVADs (Heartmate VE/XVE) and 294 patients without LVAD support.
- Kaplan-Meier survival analysis and log-rank testing were employed.
Main Results:
- Overall 1-year survival was 86%.
- One-year survival was comparable between the LVAD group (83%) and the non-LVAD group (87%), with no statistically significant difference (P = .77).
- Patients bridged with LVADs had a significantly higher rate of death within 30 days post-transplant (80%) compared to those without LVADs (19%; P < .01).
Conclusions:
- Pretransplant LVAD use does not compromise 1-year survival after cardiac transplantation.
- Patients bridged with LVADs exhibit an increased risk of early mortality within 30 days post-transplant.
- LVADs should be considered for carefully selected patients awaiting cardiac transplantation.
Objective:
Left ventricular assist devices are increasingly used as a bridge to transplantation. It remains unclear whether the use of pretransplant left ventricular assist devices adversely affects short-term survival after cardiac transplantation.
Methods:
A retrospective review of 317 consecutive patients undergoing cardiac transplantation at an academic center between 1986 and 2006 was undertaken. Left ventricular assist devices were used pretransplant in 23 of these 317 patients, and 294 patients did not require left ventricular assist device support. Patients with a left ventricular assist device were supported with a Heartmate VE or Heartmate XVE (Thoratec Corp, Pleasanton, Calif). Kaplan-Meier survival estimates were compared between the left ventricular assist device group and the non-left ventricular assist device group using the log-rank test. In addition, occurrence of death was analyzed between the 2 groups with a chi-square analysis. The results are expressed as 1-year survival with 95% confidence intervals in parentheses.
Results:
The 1-year survival for all 317 patients was 0.86 (0.82-0.90). The patient survival for the group without a left ventricular assist device before cardiac transplant was 0.87 (0.83-0.90), and the survival for the group with a left ventricular assist device as bridge to transplantation was 0.83 (0.67-0.98; P = .77). For the deaths that occurred in all 317 patients, 19% of the patients without left ventricular assist devices died within 30 days of transplant, whereas 80% of the patients with left ventricular assist devices died within 30 days of transplant (P < .01).
Conclusion:
When used as a bridge to transplantation, left ventricular assist devices do not compromise 1-year survival after cardiac transplantation. Of the patients who die after transplantation, patients bridged with left ventricular assist devices are at higher risk for death within 30 days of transplant. These data suggest that left ventricular assist devices as a bridge to transplantation should be considered for appropriately selected patients awaiting cardiac transplantation.
